Concepts of Health, Wellness,

and Well-Being

Dr Eman
 Concepts of Health, Wellness, and Well-Being
 Health, wellness, and well-being have many definitions and interpretations.

 The nurse should be familiar with the most common aspects of the concepts and consider how
they may be individualized with specific clients.
 Health
 Traditionally health was defined in terms of the presence or absence of disease.

 According to the Nightingale – "Health is a state of being well and using every power of the
individual processes to the fullest extent”.

 Soundness of body or mind; that condition in which their functions are duly and efficiently
discharge (Oxford English Dictionary).

 American Nurses Association (ANA) states, “Health and illness are human experiences.

 The presence of illness does not preclude health, nor does optimal health preclude illness” (ANA,
2010).
 Health (Con…)
According to the WHO "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease"

These are four dimensions emerge :-

 Physical.

Mental

Social .

spiritual.

 Physical well-being :- means having the physical strength, and energy to work towards your goals.

 Mental well-being :- is ability to cope with the world in a way that brings you satisfaction.

 Social well-being:- means development of relationships with others – both with people in your immediate surroundings and with the
larger community through cultural, spiritual and political activities
Health (Con…)
Perception of Health
Health is a highly individual perception.

Many people describe health as the following:

 Being free from symptoms of disease and pain.

 Being able to be active and to do what they want or must.

Being in good spirits most of the time.

 Population Health
 The term population health has many definitions, but most include the concept of the
health of a group of individuals linked to but different from epidemiology, public
health, and community health.

 Population health includes aspects of public health, healthcare delivery systems, and
determinants of wellness and illness, emphasizing promotion, restoration, and
maintenance of wellness and prevention of disease.
What are Wellness and Well-Being??
Well-Being
 Wellbeing viewed as a “function of life opportunities and achievements”.

 Wellbeing is multidimensional, reflecting people’s functioning such as consumption and

personal security and their capabilities
Wellness
 Wellness is a state of well-being.

 Wellness is an active process by which an individual progresses towards maximum potential possible,
regardless of current state of health.

 Basic aspects include:

◦ Self-responsibility

◦ An ultimate goal

◦ A dynamic, growing process

◦ Daily decision-making in areas related to health

◦ Whole being of the individual

Components of Wellness
 Models of Health and Wellness
Because health is a complex concept, various researchers have developed models or paradigms to explain
health and, in some instances, its relationship to illness or injury.

Models of health include:-

 Clinical model.

Performance model.

Adaptive model.

Eudaimonistic model.

Agent–host–environment model.

Health–illness scales
Clinical Model
 The narrowest interpretation of health occurs in the clinical model.

 According to the model:-

◦ Health is seen as freedom from disease

◦ Illness is seen as the presence of disease

 Many practitioners have used the clinical model in their focus on the relief of signs and symptoms of
disease.

 When these signs and symptoms are no longer present, the practitioner considers the individual’s
health restored.
Role Performance Model
 Health is defined in term of the individual ability to perform work, which is fulfil the societal
roles.
 According to the model:-

Health is seen as the ability to fulfill societal roles.

Illness is seen as the inability to fulfill societal roles.

 According to this model, individuals who can fulfill their roles are healthy even if they have
health problems.
Adaptive Model
 This model is based on the ability to adapt to the environment and interact with it.
 According to the model –
◦ Health is seen as adaptation
◦ Illness is seen as a failure of adaptation, or maladaptation

 The aim of treatment is to restore the ability of the individual to adapt.

Eudaimonistic Model
 The Eudemonistic model is the most comprehensive, holistic, view of health.

 According to the model –

◦ Health is actualization or realization of one's potential

◦ Illness is seen as the failure to actualize or realize one's potential

 In this model, the highest aspiration of individuals is fulfillment and complete development,
which is actualization.

 Illness, in this model, is a condition that prevents self-actualization.

 Agent–Host–Environment Model
 The agent host environment model describes the cause of illness.

 It is used primarily in predicting illness rather than promoting wellness.

 The model is composed of three dynamic, interactive elements: –

Agent

Host

Environment

 According to the model the health and illness -

◦ Health is seen when all three elements are in balance

◦ Illness is seen when one, two, or all three elements are not in balance
The Agent-Host-Environment triangle
 Agent–Host–Environment Model (Con..)
 Agent :-

Any environmental factor or stressor (biological, chemical, mechanical, physical, or psychosocial) that by its presence or absence (e.g., lack
of essential nutrients) can lead to illness or disease.

 Host:-

 Individual(s) who may or may not be at risk of acquiring a disease.

Family history, age, and lifestyle habits influence the host’s reaction.

 Environment:-

All factors external to the host that may or may not predispose the individual to the development of disease.

The physical environment includes climate, living conditions, sound (noise) levels, and economic level.

 Social environment includes interactions with others and life events, such as the death of a spouse.
Health–Illness Scales
 Health–illness scales (grids or continua) can be used to measure an individual’s perceived
level of wellness.
 Health-illness continua
 Dunn's High-Level Wellness Grid
Illness–Wellness Continuum
 Health-illness continua
 Measure person's perceived level of wellness.
Health and illness/disease opposite ends of a health continuum.
Move back and forth within this continuum day by day.
Wide ranges of health or illness
 Dunn's High-Level Wellness Grid
Dunn's High-Level Wellness Grid composed of two axis's:-
◦ a health axes which ranges from peak wellness to death
◦ a environmental axes which ranges from very favorable to very unfavorable

 The two axis's form four quadrants:-

◦ High-level wellness in a favorable environment
◦ e.g., a person who implements healthy life-style behaviors and has the biopsychosocial spiritual resources to support this life-style
◦ Emergent high-level wellness in an unfavorable environment
◦ e.g., a woman who has the knowledge to implement healthy life-style practices but does not implement adequate self-care practices because of family
responsibilities, job demands, or other factors
◦ Protected poor health in a favorable environment
◦ e.g., an ill person whose needs are met by the health care system and who has access to appropriate medications, diet, and health care instruction
◦ Poor health in an unfavorable environment
◦ e.g., a young child who is starving in a drought ridden country
 Health Status, Beliefs, and Behaviors
Health status.

 State of health of an individual at a given time.

A report of health status may include anxiety, depression, or acute illness and thus describe the individual’s problem in general.

Health beliefs.

 Concepts about health that an individual believes are true.

Such beliefs may or may not be founded on fact.

Some of these are influenced by culture, such as the “hot–cold” belief system of some Asian, Hispanic, Filipino, and other groups.

Health behaviors.

The actions individuals take to understand their health state, maintain an optimal state of health, prevent illness and injury, and reach their maximum
physical and mental potential.

 Behaviors such as eating wisely, exercising, paying attention to signs of illness.

Variables Influencing Health Status, Beliefs, and Behaviors
Internal (non-modifiable)Variables include:

Biological Dimension: Genetic makeup, sex, age, and developmental level all significantly
influence an individual’s health.

Psychologic Dimension: include mind–body interactions and self-concept.

Cognitive Dimension: include lifestyle choices and spiritual and religious beliefs
External Variables affecting health include:-

Environmental :-
◦ Geographical location
◦ Housing
◦ Sanitation
◦ Climate
◦ Pollution of air, food, water

 Standard of living :-
◦ Class of family
◦ Occupation
◦ Economic levels
◦ education

Family and cultural belief's:-

◦ pattern of daily living

Social dimension:-
◦ Social network (Family, Friends )
◦ Job satisfaction
 Health Belief Models
Several theories or models of health beliefs and behaviors have been developed to help determine whether an individual is

likely to participate in disease prevention and health promotion activities.

These models can be useful tools in developing programs for helping individuals with healthier lifestyles and more

positive attitudes toward preventive health measures.

Example:-

 Health Locus of Control Model: whether clients believe that their health status is under their own or others’ control.

Rosenstock and Becker’s health belief model is based on the assumption that health-related action depends individual
perceptions, modifying factors, and variables likely to affect initiating action
Health Belief Models (Con..)
 Nurses play a major role in :

 Helping clients implement healthy behaviors.

 Helping clients monitor health, they supply anticipatory guidance, and they impart knowledge
about health.

 Reducing barriers to action.

Healthcare Adherence
 Adherence is the extent to which an individual’s behavior (e.g., taking medications, following
diets, or making lifestyle changes) coincides with medical or health advice.

 Another term used synonymously with adherence is conformance.

 The degree of adherence may range from disregarding every aspect of the recommendations to
following the total therapeutic plan.
 Factors Influencing Adherence
• Client motivation to become well
• Degree of lifestyle change necessary
• Perceived severity of the healthcare problem
• Value placed on reducing the threat of illness
• Ability to understand and perform specific
behaviors
• Degree of inconvenience of the illness itself or
of the regimens
• Beliefs that the prescribed therapy or regimen will or will not
help
• Complexity, side effects, and duration of the proposed
Therapy
• Cultural heritage, beliefs, or practices that support or conflict
with the regimen
• Degree of satisfaction and quality and type of relationship with
the healthcare providers
• Overall cost of therapy or lifestyle change
 Nursing action on Non-Adherence
 Establish why the client is not following the regimen.

Demonstrate caring.

Encourage healthy behaviors through positive reinforcements.

Use aids to reinforce teaching.

Establish a therapeutic relationship of freedom, mutual understanding and mutual responsibility with
the client and support persons.
 Illness versus Disease
 Illness is a highly personal state in which the individual’s physical, emotional, intellectual,
social, developmental, or spiritual functioning is thought to be diminished.

 Disease can be described as an alteration in body functions resulting in a reduction of capacities

or a shortening of the normal lifespan.
 Illness and Disease
 Stage 1: Symptom Experiences
 Stage 1 has three aspects:
 The physical experience of symptoms.
The cognitive aspect (the interpretation of the symptoms in terms that have some meaning to the
individual).
The emotional response (e.g., fear or anxiety).
Illness and Disease (Con…)
 Stage 2: Assumption of the Sick Role
 The individual now accepts the sick role and seeks confirmation from family and friends.
 Stage 3: Medical Care Contact
Sick individuals seek the advice of a health professional either on their own initiative or at the
urging of significant others.
 When individuals seek professional advice, they are really asking for three types of
information:
1. Validation of real illness.
2. Explanation of the symptoms in understandable terms.
3. Reassurance that they will be all right or a prediction of what the outcome will be.
Illness and Disease (Con…)
 Stage 4: Dependent Client Role
 After accepting the illness and seeking treatment, the client becomes dependent on the
professional for help.
 Stage 5: Recovery or Rehabilitation
 During this stage, the client is expected to relinquish the dependent role and resume former
roles and responsibilities.
 Effects of Illness
 Impact on the Client
 A client’s usual pattern of behavior changes with illness and hospitalization, which disrupt the
client’s privacy, autonomy, lifestyle, roles, and finances.
Impact on the Family
 Nurses need to be aware that the illness of one member of a family affects all other members
Thank You